發(fā)布時間：2018-07-31 14:21

【摘要】：[目的]通過對青光眼結(jié)構(gòu)性和功能性檢查結(jié)果進(jìn)行整合得到視網(wǎng)膜神經(jīng)節(jié)細(xì)胞(Retinal Ganglion Cells,RGCs)估算值(Estimated Retinal Ganglion Cell Counts,eRGC),計算eRGC丟失率進(jìn)而評估eRGC在青光眼進(jìn)展中的應(yīng)用價值。[方法]觀察性隊列研究。共納入不同時期青光眼患者38人共69眼。所有患眼均至少接受5次連續(xù)的標(biāo)準(zhǔn)自動視野計(Standard Automated Perimetry,SAP)檢測和光學(xué)相干斷層掃描(Optical Coherence Tomography,OCT)檢測,兩種檢測需在同一天完成,且第一次和最后一次檢測的時間跨度至少為兩年。將SAP檢測所得視野(visualfield,VF)中特定位點(diǎn)敏感度、OCT檢測所得視網(wǎng)膜神經(jīng)纖維層(retinal nerve fiber layer,RNFL)的平均厚度以及患者年齡等參數(shù),代入經(jīng)驗性公式計算出SAP對應(yīng)RGC數(shù)目和OCT對應(yīng)RGC數(shù)目,計算兩者相關(guān)性。最后通過計算加權(quán)平均值得到各患眼最終的eRGC。用線性回歸分析各患眼每次隨訪的eRGC隨時間的變化,若得出的回歸方程斜率為負(fù)值且斜率即eRGC丟失率高于年齡相關(guān)RGCs丟失量(7205細(xì)胞/年)且回歸系數(shù)顯著(P0.05)則認(rèn)為有進(jìn)展。把各受試者的eRGC所得進(jìn)展情況與視野指數(shù)(visual field index,VFI)所得進(jìn)展情況、平均RNFL厚度所得進(jìn)展情況三者進(jìn)行比較分析,評估eRGC對青光眼進(jìn)展的估算價值。[結(jié)果]入組患者的基線eRGC為466949±311614。在這69眼中,9只眼(13.0%)的eRGC丟失率高于年齡相關(guān)RGCs丟失量(P0.05),即認(rèn)為存在進(jìn)展。這些患眼的eRGC丟失率均值為-67022細(xì)胞/年。用eRGC計算認(rèn)為無進(jìn)展的患眼中,eRGC丟失率均值為-16791細(xì)胞/年(7205細(xì)胞/年)。SAP對應(yīng)eRGC與 OCT 對應(yīng) eRGC 之間的相關(guān)系數(shù)(correlation coefficient)為r=0.861,P0.01。依據(jù)eRGC認(rèn)為青光眼存在進(jìn)展的患眼比例大于單獨(dú)用OCT平均RNFL厚度檢測出存在進(jìn)展的患眼比例(10.1%),也大于單獨(dú)用SAP中VFI檢測出存在進(jìn)展的患眼比例(11.6%)。有2只患眼用三種方法均測出存在進(jìn)展,有2只患眼只用eRGC測得進(jìn)展,而用VFI和平均RNFL厚度均未測出進(jìn)展。不存在同時用VFI和平均RNFL厚度測出進(jìn)展而用eRGC測不出進(jìn)展的患眼。[結(jié)論]用eRGC丟失率所得青光眼進(jìn)展例數(shù)多于單獨(dú)用VFI或單獨(dú)用平均RNFL厚度所得青光眼進(jìn)展例數(shù)。SAP對應(yīng)RGC數(shù)目與OCT對應(yīng)RGC數(shù)目之間呈現(xiàn)強(qiáng)相關(guān)性。eRGC測得無進(jìn)展的青光眼患眼eRGC丟失率仍高于正常人。利用對青光眼結(jié)構(gòu)和功能參數(shù)進(jìn)行整合得到的eRGC是一種值得被進(jìn)一步研究并應(yīng)用于臨床的新的檢測青光眼進(jìn)展的工具。
[Abstract]:[objective] to obtain the estimated value of (Retinal Ganglion cells of retinal ganglion cells (Retinal Ganglion cells) by integrating the results of structural and functional examination of glaucoma, and to calculate the eRGC loss rate and evaluate the application value of eRGC in the progression of glaucoma. [methods] observational cohort study. A total of 69 eyes of 38 patients with glaucoma at different stages were included. All eyes were examined with at least five consecutive standard automatic field of vision (Standard Automated) and optical coherence tomography (Oct). The first and last tests were performed on the same day, and the time span of the first and last tests was at least two years. The mean thickness and patient age of the retinal nerve fiber layer (retinal nerve fiber layerus) measured by Oct in the visual field (VF) were calculated by using the empirical formula to calculate the number of SAP corresponding to RGC and the number of OCT corresponding to RGC. Calculate the correlation between the two. Finally, the final eRGC of the affected eyes was obtained by calculating the weighted average. The linear regression analysis showed that the slope of the regression equation was negative and the slope of eRGC loss was higher than that of age-related RGCs (7205 cells / year) and the regression coefficient was significant (P0.05), if the slope of the regression equation was negative and the slope was higher than that of age-related RGCs (7205 cells / year), the regression coefficient was significant (P0.05). The progress of eRGC and visual field index (visual field index VFI) and the average RNFL thickness of each subject were compared and analyzed to evaluate the value of eRGC in estimating the progress of glaucoma. [results] the baseline eRGC of the patients was 466949 鹵311614. The loss rate of eRGC in 9 eyes (13.0%) was higher than that in age-related RGCs (P0.05). The average eRGC loss rate in these eyes was-67022 cells per year. The average loss rate of eRGCs was -16791 cells / year (7205 cells / year). The correlation coefficient (correlation coefficient) between eRGC and OCT corresponding to eRGC was 0.861g / year (P 0.01). According to eRGC, the proportion of glaucoma patients with progression was greater than that with OCT average RNFL thickness (10.1%), and with SAP alone (11.6%). Progress was detected by three methods in 2 eyes and only by eRGC in 2 eyes, but no progress was detected with VFI and average RNFL thickness. There were no patients with VFI and average RNFL thickness, but not with eRGC. [conclusion] the number of glaucoma progression cases with eRGC loss rate is more than that with VFI alone or with average RNFL thickness. There is a strong correlation between the number of RGC corresponding to RGC and the number of RGC corresponding to OCT. The loss rate of eRGC in glaucoma eyes is still higher than that in normal eyes. The eRGC obtained by integrating the structure and functional parameters of glaucoma is a new tool for detecting the progress of glaucoma, which is worthy of further study and clinical application.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R775

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